Journal of emergency nursing : JEN : official publication of the Emergency Department Nurses Association
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To decrease the number of hemolyzed samples in the emergency department, performance improvement activities were implemented, including phlebotomy classes for staff, evaluation of blood draw equipment, and a study to evaluate factors attributed to hemolysis of blood samples when drawn at the time a new intravenous catheter is inserted. ⋯ Clinically meaningful factors associated with hemolysis rates included the use of a 22-gauge intravenous catheter size, which resulted in a hemolysis rate of 60%; in addition, intravenous placement sites on the right side had statistically significant higher hemolysis rates than the left side, a finding that merits further research. As a result of the study we modified our standard operating procedure to discontinue the use of a 22-gauge or smaller intravenous catheter in adults. If required for small vein sticks, the use of a straight needle stick to obtain blood samples should be considered. The results of this study underscore the importance of education and training and the consideration for regular competency testing for staff with phlebotomy responsibilities.